Form Rt113 - Schedule 14b-Motor Fuel And Petroleum Products Transporter'S Report-Schedule Of Deliveries

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Schedule 14B-Motor Fuel and Petroleum Products Transporter’s Report-Schedule of Deliveries
Company Name:
FEIN:
Month/Year:
Product Type (Circle One)
065
Gasoline
161
Low Sulfur No. 1 Diesel Fuel
227
Low Sulfur Diesel Fuel (dye added)
125
Aviation Gasoline
167
Low Sulfur No. 2 Diesel Fuel
___
Other
130
Jet Fuel
226
High Sulfur Diesel Fuel (dye added)
Person Hiring the Carrier
Delivered to:
(10)
(11)
(12)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Date
Document
Gross
Company Name
FEIN
Company
FEIN
Mode
Origin
Name
Address
FEIN
Delivered
Number
Gallons
Name
TOTAL:
SEE REVERSE SIDE FOR INSTRUCTIONS
RT113 –Schedule 14B (07/05)

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